Article type
Year
Abstract
Objective: To examine the effectiveness of low dose heparin, low molecular weight heparin, and physical methods (calf or foot pumps) in the prevention of deep venous thrombosis (DVT) and pulmonary embolism (PE) after surgery for proximal femoral fracture in the elderly.
Methods: A systematic review of the evidence from randomised trials which investigated the use of these interventions for this patient group was undertaken. Trials were mainly identified via electronic databases, journal searches, and review and trial bibliographies. No language restriction was applied. Two reviewers independently assessed the quality and extracted data for thrombosis, mortality and complications for trials meeting the pre-specified inclusion criteria. Where appropriate, the results of outcome measures were pooled.
Results: Twenty-six trials were included in the review. Both heparin (odds ratio 0.41; 95% confidence interval 0.30-0.56) and low molecular weight heparin significantly reduce the incidence of lower limb DVT after surgery for hip fracture. Evidence is lacking for the efficacy of either agent in the prevention of PE. For any heparin prophylaxis, there is a trend towards reduction of fatal PE (OR 0.39; 95%CI 0.14-1.09) but for overall mortality, the trend is unfavourable (OR 1.39; 95%CI 0.86-2.23). Data are inadequate to demonstrate any effect of heparins on wound complications. Mechanical devices protect against DVT (OR 0.24; 95%CI 0.13-0.44) and demonstrate a trend towards protection both against fatal PE (OR 0.25; 95%CI 0.05-1.25) and against all cause mortality (OR 0.36; 95%CI 0.12-1.09).
Discussion: Injectable anticoagulants (low dose heparin and low molecular weight heparin) protect against the formation of lower limb DVT and may also protect against fatal PE. However an increase in mortality from causes other than PE is apparent. The use of foot and calf pumping devices appears to be of similar efficacy to injectable anticoagulants in the prevention of DVT and may protect against fatal PE without an increase in other cause mortality. Further clinical trials are required.
Methods: A systematic review of the evidence from randomised trials which investigated the use of these interventions for this patient group was undertaken. Trials were mainly identified via electronic databases, journal searches, and review and trial bibliographies. No language restriction was applied. Two reviewers independently assessed the quality and extracted data for thrombosis, mortality and complications for trials meeting the pre-specified inclusion criteria. Where appropriate, the results of outcome measures were pooled.
Results: Twenty-six trials were included in the review. Both heparin (odds ratio 0.41; 95% confidence interval 0.30-0.56) and low molecular weight heparin significantly reduce the incidence of lower limb DVT after surgery for hip fracture. Evidence is lacking for the efficacy of either agent in the prevention of PE. For any heparin prophylaxis, there is a trend towards reduction of fatal PE (OR 0.39; 95%CI 0.14-1.09) but for overall mortality, the trend is unfavourable (OR 1.39; 95%CI 0.86-2.23). Data are inadequate to demonstrate any effect of heparins on wound complications. Mechanical devices protect against DVT (OR 0.24; 95%CI 0.13-0.44) and demonstrate a trend towards protection both against fatal PE (OR 0.25; 95%CI 0.05-1.25) and against all cause mortality (OR 0.36; 95%CI 0.12-1.09).
Discussion: Injectable anticoagulants (low dose heparin and low molecular weight heparin) protect against the formation of lower limb DVT and may also protect against fatal PE. However an increase in mortality from causes other than PE is apparent. The use of foot and calf pumping devices appears to be of similar efficacy to injectable anticoagulants in the prevention of DVT and may protect against fatal PE without an increase in other cause mortality. Further clinical trials are required.